Tendinopathy, commonly called tendonitis, is a family of painful conditions of the tendon corresponding to a specific histopathology which involves a mechanism of tissue degeneration. Tendons are the strong, but flexible, bundles of fibrous tissue that connect muscles to your bones. Tendonitis is inflammation that occurs in tendons, typically feel like a dull ache around the affected area and painincreases with movement or touching.
Most of the cases, tendonitis is more common in the heel, knee and shoulder area.
In everyday language, the term tendonitis is misused to designate any tendinopathy (or painful tendon). Indeed, the suffix “-pathy” designating the presence of an inflammatory phenomenon is not suitable, the tendon tissue biopsy having shown an absence of cells (macrophages, lymphocytes or neutrophils) and inflammatory molecules on site.
Tendinopathies actually include: tendinosis (a state of chronic non-inflammatory degeneration) and paratenonitis or tenosynovitis (with inflammatory damage to the synovial sheath causing swelling of the latter and therefore compression of the tendon favoring its deterioration in movement, hypervascularization of tendon sheath and fibrous exudate). In clinical practice, it is not possible to distinguish these three different histopathologies and the term “tendinopathy” is therefore proposed to designate these three conditions of the painful tendon. An ultrasound or an MRI will be necessary to establish a more certain diagnosis. Tendinopathies can be included in musculoskeletal disorders.
pain on palpation of the tendon;
pain when tensioning the tendon muscle;
painful feeling of hooking during movements involving the tendon;
nodules of the tendon (chronic tenosynovitis resulting in fibrosis).
The diagnosis will be confirmed by an MRI or ultrasound.
Location of Tendonitis
Tendinopathies mainly affect the tendons at:
wrist, which can lead to carpal tunnel syndrome;
elbow, causing epicondylitis (more commonly known as “tennis elbow”) or epitrochleitis (golfer’s tendinosis);
the rotator cuff (shoulder), which causes rotator cuff tendinopathy;
sural triceps or calcaneal tendon (Achilles tendon);
tensor fascia lata, causing iliotibial band syndrome or “wiper syndrome” in the knee;
But also :
crow’s feet, linked to rotation, tendonitis generally observed in cyclists;
quadriceps or patellar tendon.
talalgia, inflammation of a weakened heel, in the runner, the footballer and the basketball player, or in general all the sportsmen practicing jumping exercises. In addition, in the event of doping, the simultaneous intake of fluoroquinolone and a corticosteroid may in rare cases lead to rupture of the Achilles tendon.
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow, also called epicondylitis, is a rather particular tendonitis (inflammation of the tendon) insofar as it is an insertion tendonitis. “The tendon is detached from the bone support, the lateral epicondyle”.
Contrary to what its name suggests, tennis elbow is not necessarily due to playing tennis. This tendonitis is even more often linked to professional or domestic activity than to the practice of a sport. Certain movements: tightening a handle (hammer, tool) with force work, rotating the forearm and flexing the wrist and hitting objects are risk factors for epicondylitis.
In addition, certain elements aggravate the lesions of the tendons such as the repetition of harmful gestures, the absence of rest or recovery time, cold work and exposure to vibrations.
intense and / or repeated efforts: assembly line work, or at the athlete’s and the musician’s;
Osteopathic dysfunctions leading to a modification of the work axis of the tendon: frequent cause of unilateral tendinopathies;
smoking, because it causes obstruction of the vessels bringing blood to the tendons;
metabolic diseases, such as diabetes, hypercholesterolemia or dyslipidemia, which also lead to obstruction of the vessels;
certain parasitoses or infectious diseases (example: in Lyme disease due to certain borrelias that can be transmitted by tick bites, at the 2nd or 3rd stage, some patients develop recurrent tendinopathies, synovitis or bursitis).
In all cases, complete healing of tendinopathy can be long (6 months) and requires, in the case of tendinopathy caused by repeated movements, the cessation of the offending movement.
The rest of the tendon remains debated, many studies since 2000 advising a relative rest, by making the tendon work progressively increasing, after having a short period of initial immobilization by compression with splint [ref. desired].
physiotherapy: The most commonly used treatment consists of tendon stimulation using various tools such as: radial shock waves [ref. necessary] derived from extracorporeal lithotripsy, ultrasound, stretching, eccentric strengthening, deep transverse massage. All these techniques generally act in the same way: they offer stimulation of the tendon in the direction of its fibers and promote the creation of type I collagen on the part of the tenocytes, reduce the pathological quantity of fundamental substance within the tendon, promote fibroblast activity and restore a healthy balance between metalloproteases and inhibitors thereof.
Cryotherapy: The use of cryotherapy has shown some benefit in reducing the pain of the patient. As no inflammation takes place on site, its vasoconstrictor effect could only reduce the appearance of the proto-blood vessels mentioned above.
NON-cortisonic infiltrations: The infiltrations of steroidal anti-inflammatory drugs or not in cases of tendinosis tend to limit the quality of healing of the tendon and increase the risk of recurrence or even rupture of the tendon. On the other hand, the infiltrations of PRP (platelet rich-plasma), blood plasma enriched in leukocytes and platelets, obtained after centrifugation of a blood sample from the patient, have shown definite efficacy in the management of tendinosis.
Non-steroidal anti-inflammatory drugs can only be useful in the case of tenosynovitis, with therefore inflammation of the synovial sheath of the said tendon (attested by ultrasound or MRI).